Provider Demographics
NPI:1033282405
Name:SCOTT COUNTY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:SCOTT COUNTY MEDICAL CLINIC INC
Other - Org Name:SCOTT COUNTY IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-569-8462
Mailing Address - Street 1:PO BOX 5420
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841
Mailing Address - Country:US
Mailing Address - Phone:423-569-8462
Mailing Address - Fax:423-569-2577
Practice Address - Street 1:19268 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-569-8462
Practice Address - Fax:423-569-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0270796261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4102363OtherBCBS
TN4053668Medicaid
TN4053668Medicaid